Page 319 - Ebook health insurance IC27

Sashi Publications

recoverable under the policy by an insured member during any one period of insurance
of one year."

Definitions
The purpose of definitions is to define clearly the meaning of key words or phrases so
that coverage under the policy can be determined easily. One must bear in mind that not
all types of policies contain a definition section. However it is becoming more and more
common to include such section in an attempt to make insurance policies as conspicuous,
plain and clear as possible.

Among common words defined under most of the policies include medical expenses,
accidental bodily injury, illness, employer, employee, dependant, insured member,
deductible, physician, hospital, usual country of residence, reasonable and customary
charges, pre-existing condition and due date. A detailed definition of each is mentioned
later.

Eligibility
Thisclausedefinespersonseligibleforinsurance.Underindividual insurance,all individuals
who are below the upper limit for age and are legally qualified for contracting are eligible
to become an insured member. Most companies usually state an upper limit of 65 for
age.

For groups, all existing employees shall become insured members as from the date of
commencement of the insurance cover, subject to the employee being actively at work
(or on normal annual leave) on that date. If absent from work through reason of injury

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